PCSK9 Inhibitors - the new way to screw the NHS for every last penny

Did you hear the “Amazing” news about the new generation of Statin drugs that was announced at the weekend? The new PCSK9 inhibitors like Evolocumab are even more effective at lowering LDL cholesterol and according to many this makes them a wonder drug.

The issue with statin trial data was simply a question of whether it is actually valid to rate a drug on a surrogate endpoint such as lowering cholesterol rather than that of saving lives. However the trials for Evolocumab went further than this, they provided real data on the expected outcomes for patients. Great?

It was a surprise to me that these new drugs need to be taken as well as a statin; so the question of the side-effects of statins is still very much alive. Again the advocates such as Professor Rory Collins will claim that the benefits vastly outweigh the side-effects, but this article in Today’s Times puts that argument to the sword.

Put simply, the number of people that need to be prescribed Evolocumab (at more than £10 a day) to prevent one of them having a stroke or heart attack is 74. Yes, 74 people need to take the drug every day for two years, in addition to a statin, to prevent just one of them having a stroke or heart attack.  

Just to repeat, that is 74 people and £540,200 of NHS funds in order to save one stroke or heart attack every 2 years. 

Does that sound like good news to you? Spend that money on dietary intervention and you might prolong hundreds of lives.

I worry about a number of things, but I don’t worry that my body is trying to kill me - 7 little-known facts about cholesterol

When I discuss the LCHF diet with friends, family and increasingly with my clients all over the world, the conversation generally goes like this:

1. I describe the diet and it’s effect on obesity and type 2 diebetes.
2. I talk about running on fat.
3. I talk about the fear of fat.

And it is always at stage 3 that things get difficult. We have an ingrained fear of fat, and saturated fat in particular. The way I try to get past this point is what I have coined “My Cholesterol Chat”. But I always fear that I have not got the message across as clearly or as simply as I ought be able to.

Here is a great post from Zoe Harcombe that does just that.

http://www.zoeharcombe.com/the-knowledge/we-have-got-cholesterol-completely-wrong/

A simple summary which I shall use from now on goes like this:

1. Cholesterol is of vital importance to every cell in our body. It is a good thing.
2. It is so important that we make it ourselves, we do not get it directly from the cholesterol in food.
3. There is no such thing as ‘good’ or ‘bad’ cholesterol. HDL and LDL are just the transport mechanism by which it is distributed from and returned to the liver.
4. If you lower the amount of fat in your blood (for example be losing weight on any diet) then LDL tends to be raised. Why would losing weight be bad for us?
5. Statins prevent the body from making cholesterol; this thing that is vital to every cell in our body! It is now clear that the tiny number of already ill people who do benefit from taking statins do so not because of the way it lowers cholesterol but more likely due to the way it combats inflammation. Aspirin does the same thing, but without the side-effects.
6. Eating animal foods has no impact on cholesterol levels; please stop worrying about saturated fat!
7. Lastly, consider this: Who is gaining from this whole business if the increased lifespan of the tiny number of people who do benefit from taking statins can be measured in days?

Zoe’s summary is perfect:

“The body makes cholesterol. I worry about a number of things, but I don’t worry that my body is trying to kill me.”